Geneva University Hospitals and Medical School, Geneva, Switzerland.
Int J Antimicrob Agents. 2011 Feb;37(2):110-7. doi: 10.1016/j.ijantimicag.2010.10.022. Epub 2010 Dec 15.
Based on the failure of conventional control strategies, some experts and public health officials have promoted active screening to detect asymptomatic carriers of meticillin-resistant Staphylococcus aureus (MRSA) as an effective prevention strategy. Data regarding the (cost-) effectiveness of MRSA screening have recently grown and have produced mixed results. Several clinical studies have not only provided conflicting findings but have also raised numerous issues about the appropriate populations for universal versus targeted screening, screening method(s) and intervention(s). It must also be emphasised that screening alone is not effective. Results should be followed by appropriate interventions to reduce the risk of MRSA transmission and infection. We believe a reasonable approach in most European hospitals with an MRSA on-admission prevalence of <5% is to use targeted rather than universal screening (predominantly with chromogenic media, except for high-risk units and critically ill patients for whom molecular tests could be cost effective), after carefully considering the local MRSA epidemiology, infection control practices and vulnerability of the patient population. This strategy is likely to be cost effective if linked to prompt institution of control measures.
基于传统控制策略的失败，一些专家和公共卫生官员提倡主动筛查无症状耐甲氧西林金黄色葡萄球菌 (MRSA) 携带者，将其作为一种有效的预防策略。最近，有关 MRSA 筛查的成本效益的数据不断增加，但结果喜忧参半。一些临床研究不仅提供了相互矛盾的发现，而且还提出了关于针对所有人群进行普遍筛查还是靶向筛查、筛查方法和干预措施的众多问题。还必须强调的是，单独筛查是无效的。应通过适当的干预措施来降低 MRSA 传播和感染的风险。我们认为，对于入院时 MRSA 流行率<5%的大多数欧洲医院，合理的方法是采用靶向筛查而不是普遍筛查（主要使用显色培养基，但对于高危病房和重症患者，分子检测可能具有成本效益），同时要仔细考虑当地的 MRSA 流行病学、感染控制措施和患者人群的脆弱性。如果与及时采取控制措施相结合，这种策略可能具有成本效益。
